Fall Prevention Guidelines Research Articles

Individual and Environmental Factors Associated with Recurrent Falls in Elderly Patients Hospitalized after Falls.

Falls and recurrent falls cause great health and social consequences in older people. However, these problems are poorly understood in Vietnam. A cross-sectional study was performed at seven hospitals in Thai Binh province, Vietnam, to investigate the individual and environmental factors associated with recurrent falls among elderly patients hospitalized due to fall injuries in Vietnam. A history of recurrent falls within the last 12 months, sociodemographic, health, and clinical characteristics, as well as environmental conditions, were obtained via self-reported interviews. Multivariate logistic and Poisson regression models were used to identify associated factors. Overall, the mean fall episodes in the last 12 months were 1.8 (Standard deviation—SD = 1.2) episodes, and the 12-month prevalence of recurrent falls was 40.5%. The individual risk factors included not receiving fall prevention guidelines, walking with devices, loss of sensation in hand or foot, and using pain relief medications. The environmental risk factors comprised having too-high stairs and not having dry, clean, and nonslippery bathrooms. This study highlights a significantly high 12-month prevalence of recurrent falls in older patients hospitalized after falls in Vietnam. Moreover, regular assessments of functional disabilities and hazardous environmental conditions, as well as the provision of prevention programs, have potential to prevent falls and recurrent falls.

Chronic medical condition associated with increased risk of fall in old people: a review

Background: Falls are defined as unintentional events that happened when a person losing his/her center of gravity leading him/her to fall and without effort to restore balance, or this effort is ineffective. This review aims to provide and represent the most common updated comprehensive review of studies conducted on chronic medical condition that associated with a higher risk of fall in elderly people. Methods: A review was conducted up to May 2020 using the databases PubMed and Google Scholar. The exclusion criteria include papers published before 2000, papers linking risk of fall in acute medical condition, and papers linking risk of fall in people younger than 65. All duplicates were erased and screened by the title, abstract, and full text. Results: It was reported that chronic obstructive pulmonary disease (COPD) is one of the chronic diseases with the highest prevalence of falls among the elderly. Anemia is a universal public health issue affecting human health, and it was associated with twice the incidence of recurrent falls. The risk of falls among the elderly reported that the risk of falls is approximately seven times higher in hypertensive patients than in those who are not affected by this morbidity with p-value 65 years and diabetes increases the risk of falling by 17-fold. The risk of fall in chronic kidney disease (CKD) patient aged 65-year old or older is higher compared to people without CKD. The fall frequency in rheumatoid arthritis (RA) patients appears to be age independent. Parkinson’s disease occurs in about 4%-5% of patients aged 85 years or older. People with dementia have a significantly higher risk of falling than those without. Depression is considered as one of the common risks of falling in the elderly, and the prevalence of open-angle glaucoma increases the double in diabetic people compared to nondiabetic. Conclusion: The studies found that patients with COPD, anemia, hypertension, orthostatic hypertension, diabetes mellitus, chronic kidney diseases, RA, Parkinson’s diseases, Alzheimer’s disease, depression, and glaucoma are at increased risk of a fall by direct and indirect ways. Assessment and fall prevention guidelines should be considered in patients with this chronic medical condition.

Investigating multisite pain as a predictor of self-reported falls and falls requiring health care use in an older population: A prospective cohort study.

Older people are continuing to fall despite fall prevention guidelines targeting known falls’ risk factors. Multisite pain is a potential novel falls’ risk factor requiring further exploration. This study hypothesises that: (1) an increasing number of pain sites and widespread pain predicts self-reported falls and falls recorded in primary and secondary healthcare records; (2) those relationships are independent of known falls’ risk factors and putative confounders. This prospective cohort study linked data from self-completed questionnaires, primary care electronic health records, secondary care admission statistics and national mortality data. Between 2002–2005, self-completion questionnaires were mailed to community-dwelling individuals aged 50 years and older registered with one of eight general practices in North Staffordshire, UK(n = 26,129) yielding 18,497 respondents. 11,375 respondents entered the study; 4386 completed six year follow-up. Self-reported falls were extracted from three and six year follow-up questionnaires. Falls requiring healthcare were extracted from routinely collected primary and secondary healthcare data. Increasing number of pain sites increased odds of future 3 year (odds ratio 1.12 (95% confidence interval: 1.01–1.24)) and 6 year self-reported fall (odds ratio 1.02 (1.00–1.03)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.01 (1.00–1.03)). The presence of widespread pain increased odds of future 3 year (odds ratio 1.27 (0.92–1.75)) and 6 year fall (odds ratio 1.43(1.06–1.95)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.27(0.98–1.65)). Multisite pain was not associated with future fall requiring secondary care admission. Multisite pain must be included as a falls’ risk factor in guidelines to ensure clinicians identify their older patients at risk of falls and employ timely implementation of current falls prevention strategies.

Falls in individuals with stroke during inpatient rehabilitation at a tertiary care hospital in Saudi Arabia.

Objectives:To determine the incidence and risk factors of falls in individuals with stroke undergoing inpatient rehabilitation.Methods:Retrospective analysis of all patients with stroke admitted to from January 2011 to June 2013 was carried out in Inpatient rehabilitation Unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. Data collected included demographic variables, types of stroke, comorbidities, characteristics of falls, factors affecting falls and length of hospital stay. Data was descriptively analyzed. The Pearson Chi-square test was used to determine any significant relationship between the categorical variables. Binary logistic regression was used to evaluate predictors of falls during rehabilitation.Results:Results: Out of 146 stroke survivors, 36 patients had a fall during inpatient rehabilitation. Majority did not sustain any injury. Fall status was significantly associated with age group (p=0.048), type of stroke (p=0.005) and previous history of stroke (p=0.020). The side of stroke (p=0.011) and fall risk were statistically significantly related to fall outcomes (p=0.005). Length of hospital stay (LOS) was also associated with fall outcome (p=0.044).Conclusion:Age, hemorrhagic stroke, laterality of stroke and previous history of stroke were identified as risk factors associated with falls. Injured patients tend to stay longer for inpatient rehabilitation. Due to different culturual, environmental and health system variations, development of regional guidelines for fall prevention in stroke survivors can help to reduce the risk of falls.

Occupational therapist led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service.

Environmental assessment and modification is an effective approach to reducing falls, particularly when provided by occupational therapists to high risk populations. Environmental assessment and modification has been incorporated into many national and international falls prevention guidelines, however, evidence suggests that it is not being implemented in practice. The aim of this study is to identify factors that support the local adoption of best practice environmental assessment for falls prevention within a rural health service. A concurrent mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services framework was employed. The setting was a health service in Queensland, encompassing rural and regional populations. An audit, based on best practice, was conducted on eligible medical charts. An online survey of occupational therapists' knowledge, attitudes, confidence and experience of environmental assessment and modification was completed. Focus group discussions were also carried out. Quantitative data were presented using descriptive statistics and discussions were thematically analysed. Twenty-four occupational therapists were identified as meeting the inclusion criteria. Fourteen participated in the survey and 12 of those surveyed also participated in the focus groups. Fifty-eight patients' medical charts were audited, which included entries from occupational therapists who completed the survey and focus groups and some who did not. Survey results identified that most occupational therapists were aware of, confident, and experienced in environmental assessment and modification for falls prevention. Chartaudits, however, revealed that none of the patients received this intervention. Thematic analysis of focus group discussions identified three key themes which influenced uptake of environmental assessment and modification: confidence in, and awareness of evidence; key stakeholders' support and knowledge of occupational therapy; and, perceived impact of time and resources required for implementation. Results also suggested that several contextual issues unique to rural and regional service delivery influenced uptake, including: geographical and sociocultural diversities of communities being served; differing organisational structures which result in occupational therapists being line managed by other professions; and, limited access to professional development. Availability of local peer support, and engagement of multiple stakeholders from various professions were highlighted as key facilitators to support change. Occupational therapists reported that they carried out best practice environmental assessment and modification for falls prevention but the medical chart audit provided no evidence of this happening in practice. This discrepancy requires further investigation. This study provided an understanding of factors that influence whether occupational therapists implement best practice environmental assessment and modification in a rural health service. Findings could be used to guide the translation of evidence into practice across similar settings.

An Explorative Study to Prevent the Incidence of Inpatient Falls in a Tertiary Care Hospital

Improving patient care has become a top priority among healthcare providers, with the overall interest to achieve patient satisfaction. The quality of patient care is the adoption of a system which is patient centred or patient oriented. One such area in the hospital for improvising the quality of patient care is the prevention of patient falls. The study was carried out in the inpatients wards of a tertiary care hospital in Bangalore for a period of five months, from March 2018 to July 2018 which was cross sectional study descriptive in nature. Data on inpatient falls was collected through hospital incidence report for three years. An observational checklist was prepared to check for patient safety compliance to environmental circumstances and a self-administered questionnaire to assess the level of knowledge of nurses on fall prevention. Data analysis was done by using Quality control tools such as Pareto's Chart, Cause and Effect Diagram and bar graphs to identify the gaps and analyse the root cause for inpatient falls in the hospital. As a result of data analysis, it was concluded that the major reasons for patient falls were due to patient related factors such as old age, weakness, loss of balance, impaired cognition and environmental factors such as wet bathroom floors, absence of patient call bells and bed rails not being raised. On the other hand evaluating the level of knowledge of nursing staffs on fall prevention revealed that 3.25% of the nurses had poor knowledge regarding the fall risk assessment, 31.33% of the nurses had less knowledge on risk factors and 15.25% were not aware of interventions for fall reduction. Overall the hospital had to improve on fall prevention strategies and conduct periodic training programs for nurses on fall prevention. An environmental safety checklist was prepared and Standard fall prevention guidelines was formulated and recommended to the hospital.

Implementing Fall Prevention Guidelines with Vulnerable Older Adults: The Social Work Role

ABSTRACTFalls are the leading cause of injury among the older adult population, resulting in costly and devastating aftermaths. National fall prevention guidelines (FPGs) have been established to assist healthcare professionals with addressing fall risk, but little is understood about the extent to which FPGs have been implemented by social workers. Social workers, however, may beuniquely positioned to implement FPGs with older adults due to their expertise in care coordination and home- and community-based service settings. This conceptual paper addresses the timely issue of fall prevention and social workers’ potential role in implementing FPGs to address fall risk.

Simulating the effects of a clinical guidelines screening algorithm for fall risk in community dwelling older adults

BackgroundThe current guidelines for fall prevention in community-dwelling older adults issued by the American Geriatrics Society and British Geriatrics Society (AGS/BGS) indicate an algorithm for identifying who is at increased risk of falling. The predictive accuracy of this algorithm has never been assessed, nor have the consequences that its introduction in clinical practice would bring about.AimsTo evaluate this risk screening algorithm, estimating its predictive accuracy and its potential impact.MethodsThe analyses are based on 438 community-dwelling older adults, participating in the InCHIANTI study. We analysed different tests for gait and balance assessment. We compared the AGS/BGS algorithm with alternative strategies for fall prevention not based on fall risk evaluation.ResultsThe AGS/BGS screening algorithm (using TUG, cut-off 13.5 s) has a sensitivity for single falls of 35.8% (95% confidence interval 23.2%–52.7%) and a specificity of 84.0% (79.3%–88.4%). It marks 18.0% (13.7%–22.4%) of the older population as at high risk. A policy of targeting people with preventive intervention regardless of their individual risk could be as effective as the policy based on risk screening but at the price of intervening on 17.3% (4.1%–34.0%) more people of the older population.DiscussionThis study is the first that validates and estimates the impact of the screening algorithm of these guidelines. Main limitations are related to some modelling assumptions.ConclusionsThe AGS/BGS screening algorithm has low sensitivity. Nevertheless, its adoption would bring benefits with respect to policies of preventive interventions that act regardless of individual risk assessment.

Mismatch between risk factors and preventive interventions? A register study of fall prevention among older people in one Swedish county.

Falls are a common and often a devastating health hazard for older people, causing suffering, morbidity and mortality. Falls are costly for society in terms of both resources and direct medical costs. Although knowledge about falls and fall prevention is well known, falls among older people are still a major problem. The aim was to estimate the prevalence of the risk of falls among older people receiving municipal health care. A further aim was to investigate the consistency between fall risk factors and preventive nursing interventions. A cross-sectional register study. Data containing risk assessments based on the Downton Fall Risk Index (DFRI) and planned interventions by the municipal health care were collected from the Swedish national quality registry, Senior Alert. Data were analysed using descriptive and analytic statistics. In the sample of 5,427 older people, the prevalence of the risk of falling was 79%. There was a difference in prevalence between the different types of municipal health care, sex and age. The most common preventive intervention was environment adjustments, and the least planned intervention was information/education about falls. Physical activity as an intervention was planned among 13.2% of the participants. Approximately 27% of the older people did not have any planned interventions despite being at risk of falling. Planned interventions did not always correspond with the risk factors; for instance, only 35.4% of those at risk of falling due to medication obtained pharmaceutical reviews as a preventive measure to decrease the risk. The risk of falling is common among older people, and the preventive interventions do not sufficiently follow current evidence. This implies that systematic implementation of fall-prevention guidelines is needed in municipal care. A better match between identified risk factors and preventive interventions is warranted.

Community Peer-Led Falls Prevention Presentations: What Do the Experts Suggest?

Falls among older adults are a major problem. Despite considerable progress in falls prevention research, older adults often show low motivation to engage in recommended preventive strategies. Peer-led falls prevention education for older adults may have potential for bridging the research evidence-practice gap, thereby promoting the uptake of falls prevention strategies. We evaluated peer educators' presentations of falls prevention education to community-dwelling older adults in regard to established criteria that were consistent with adult learning principles, the framework of health behaviour change, falls prevention guidelines, and recommendations for providing falls prevention information. We conducted a within-stage mixed model study using purposive and snowball sampling techniques to recruit 10 experts to evaluate video recordings of the delivery of three peer-led falls prevention presentations. Each expert viewed three videos and rated them usinga questionnaire containing both open-ended and closed items. There was a good level of expert agreement across the questionnaire domains. Though the experts rated some aspects of the presentations highly, they thought that the presentations were mainly didactic in delivery, not consistently personally relevant to the older adult audience, and did not encourage older adults to engage in the preventive strategies that were presented. Based on the experts' findings, we developed five key themes and recommendations for the effective delivery of peer-led falls prevention presentations. These included recommending that peer educators share falls prevention messages in a more interactive and experiential manner and that uptake of strategies should be facilitated by encouraging the older adults to develop a personalised action plan. Findings suggest that if peer-led falls prevention presentations capitalise on older adults' capability, opportunity, and motivation, the older adults may be more receptive to take up falls prevention messages.

Comparison of Content Coverage of Domestic and International Inpatient Falls Prevention Guidelines Using Standard Nursing Terminologies

Purpose: The purpose of this study was to compare the content of the falls prevention guideline developed by Korean Hospital Nurses’ Association (KHNA) in 2008 with the seven guidelines recommended by The Joint Commission. Methods: The contents of the eight guidelines were categorized into eight assessment, eight intervention, and two outcome elements that were considered core concepts of individual nursing activities. Concept-level comparisons were conducted using the International Classification for Nursing Practice, and the Logical Observation Identifiers, Names, and Codes. Two researchers independently examined the content coverage of each guideline and assigned 1 point to included content, 0 to excluded content, and 0.5 to similar content that was ambiguous in terms of a broader expression. The scores were compared, with discordance among raters resolved through consensus-based discussions. Results: The communication element in the assessment area was missing from the KHNA guideline, while five elements of pathophysiologic, mental/cognitive, therapeutic, and post-fall assessments showed lack of content. Although there were no missing elements in the intervention area, the three elements of staff communication, risk-targeted, and post-fall interventions showed considerable lack of content compared to the other guidelines. In terms of outcomes, the severity of fall-related injury was omitted, and the facility’s policy on falls prevention was not addressed. Conclusion: Many nursing elements and key concepts were missing from the KHNA guideline, and its content was not comprehensive. This suggests that the current guideline needs to be revised urgently, and the points identified in this study should be considered a high priority.

A Sustainability Oriented and Mentored Approach to Implementing a Fall Prevention Guideline in Acute Care Over 2 Years.

The purpose of this study was to assess the impact of a mentored guideline implementation (Registered Nurses’ Association of Ontario Prevention of Falls and Falls Injuries in the Older Adult Best Practice Guideline) focused on enhancing sustainability in reducing fall rates and number of serious falls and the experience of staff in three acute care hospitals. The National Health Service (NHS) Sustainability Model was used to guide the study. Interviews and focus groups were held with 82 point-of-care professional staff, support staff, volunteers, project leaders, clinical leaders, and senior leaders. Study results supported the importance of the factors in the NHS model for sustainability of the guideline in these practice settings. There were no statistically significant decreases in the overall fall rate and number of serious falls. The results supported strategies of participating hospitals to become senior friendly organizations and provided opportunities to enhance staff collaboration with patients and families.

IMPLEMENTATION OF VITAMIN D FOR OLDER PEOPLE IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES

In residential aged care facilities one in every two residents will fall each year. There is strong evidence for Vitamin D supplement use for the reduction of falls in these facilities, and Vitamin D supplementation is recommended in current best practice falls prevention guidelines for aged care facilities. This presentation reviews current usage of Vitamin D in a range of Australian aged care facilities, and presents effective implementation strategies including education which is multifactorial and targets all stakeholders, use of audits and feedback, and addressing stakeholder beliefs and attitudes. Contextual factors may influence the success of implementation and will vary between facilities.

Direct and indirect effects of attention and visual function on gait impairment in Parkinson's disease: influence of task and turning (Commentary on Stuart et al. (2017)).

Direct and indirect effects of attention and visual function on gait impairment in Parkinson's disease: influence of task and turning (Commentary on Stuart et al. (2017)).

Efficacy of a Student-Led, Community-Based, Multifactorial Fall Prevention Program: Stay in Balance.

Falls are a major public health concern in older adults. Recent fall prevention guidelines recommend the use of multifactorial fall prevention programs (FPPs) that include exercise for community-dwelling older adults; however, the availability of sustainable, community-based FPPs is limited. We conducted a 24-week quasi-experimental study to evaluate the efficacy of a community-based, multifactorial FPP [Stay in Balance (SIB)] on dynamic and functional balance and muscular strength. The SIB program was delivered by allied health students and included a health education program focused on fall risk factors and a progressive exercise program emphasizing lower-extremity strength and balance. All participants initially received the 12-week SIB program, and participants were non-randomly assigned at baseline to either continue the SIB exercise program at home or as a center-based program for an additional 12 weeks. Adults aged 60 and older (n = 69) who were at-risk of falling (fall history or 2+ fall risk factors) were recruited to participate. Mixed effects repeated measures using Statistical Application Software Proc Mixed were used to examine group, time, and group-by-time effects on dynamic balance (8-Foot Up and Go), functional balance (Berg Balance Scale), and muscular strength (30 s chair stands and 30 s arm curls). Non-normally distributed outcome variables were log-transformed. After adjusting for age, gender, and body mass index, 8-Foot Up and Go scores, improved significantly over time [F(2,173) = 8.92, p = 0.0; T0 - T2 diff = 1.2 (1.0)]. Berg Balance Scores [F(2,173) = 29.0, p < 0.0001; T0 - T2 diff = 4.96 (0.72)], chair stands [F(2,171) = 10.17, p < 0.0001; T0 - T2 diff = 3.1 (0.7)], and arm curls [F(2,171) = 12.7, p < 0.02; T0 - T2 diff = 2.7 (0.6)] also all improved significantly over time. There were no significant group-by-time effects observed for any of the outcomes. The SIB program improved dynamic and functional balance and muscular strength in older adults at-risk for falling. Our findings indicate continuing home-based strength and balance exercises at home after completion of a center-based FPP program may be an effective and feasible way to maintain improvements in balance and strength parameters.

Are triage questions sufficient to assign fall risk precautions in the ED?

ObjectivesThe American College of Emergency Physicians Geriatric Emergency Department (ED) Guidelines and the Center for Disease Control recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the Center for Disease Control Stop Elderly Accidents, Deaths, and Injuries Falls Prevention Guidelines, the 4-Stage Balance Test (4SBT), would improve the detection of patients at risk for falls. MethodsProspective pilot study of a convenience sample of ambulatory adults 65 years and older in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered. ResultsThe 58 participants had an average age of 74.1 years (range, 65-94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n=23) as at risk for falls, whereas the 4SBT identified 43% (n=25). Combining triage questions with the 4SBT identified 60.3% (n=35) as at high risk for falls, as compared with 39.7% (n=23) with triage questions alone (P<.01). Ten (17%) of the patients at high risk by 4SBT and missed by triage questions were inpatients unaware that they were at risk for falls (new diagnoses). ConclusionsIncorporating a quick functional test of balance into the ED assessment for fall risk is feasible and significantly increases the detection of older adults at risk for falls.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

Barriers faced by healthcare professionals when managing falls in older people in Kuala Lumpur, Malaysia: a qualitative study

ObjectiveTo explore the barriers faced by healthcare professionals (HCPs) in managing falls among older people (aged above 60 years) who have a high risk of falling.Research designThe study used a...

Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales

ObjectivesThere is an urgent need to improve the care of older people at risk of falls or who experience falls in mental health settings. The aims of this study were to evaluate the individual falls risk assessment tools adopted by National Health Service (NHS) mental health trusts in England and healthcare boards in Wales, to evaluate the comprehensiveness of these tools and to review their predictive validity. MethodsAll NHS mental health trusts in England (n=56) and healthcare boards in Wales (n=6) were invited to supply their falls policies and other relevant documentation (e.g. local falls audits). In order to check the comprehensiveness of tools listed in policy documents, the risk variables of the tools adopted by the mental health trusts’ policies were compared with the 2004 National Institute for Health and Care Excellence (NICE) falls prevention guidelines. A comprehensive analytical literature review was undertaken to evaluate the predictive validity of the tools used in these settings. ResultsFalls policies were obtained from 46 mental health trusts. Thirty-five policies met the study inclusion criteria and were included in the analysis. The main falls assessment tools used were the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT). On detailed examination, a number of different versions of the FRAT were evident; validated tools had inconsistent predictive validity and none of them had been validated in mental health settings. ConclusionsFalls risk assessment is the most commonly used component of risk prevention strategies, but most policies included unvalidated tools and even well validated tool such as the STRATIFY and the MFS that are reported to have inconsistent predictive accuracy. This raises questions about operational usefulness, as none of these tools have been tested in acute mental health settings. The falls risk assessment tools from only four mental health trusts met all the recommendations of the NICE falls guidelines on multifactorial assessment for prevention of falls. The recent NICE (2013) guidance states that tools predicting risk using numeric scales should no longer be used; however, multifactorial risk assessment and interventions tailored to patient needs is recommended. Trusts will need to update their policies in response to this guidance.

Strategies on fall prevention for older people living in the community: A report from a round-table meeting in IAGG 2013

Over the past decade, a number of programs and strategies have been proposed and developed in an effort to reduce risks among the elderly in relation to falling or sustaining fall related injuries. Programs vary in their approach, and also in their target populations. We held a round-table meeting to present each country's research data on fall prevention in older people and summarized them in order to formulate evidence-based suggestions on the prevention of falls in older people. Although the contents and level of progress of each country's studies had some differences with regards to fall prevention, the social issues of fall prevention was of particular interest in large scale cohorts studies and fall prevention guidelines. We recommended some good practice points for the strategies on fall prevention for older people living in the community based on clinical experience or expert consensus.